Survival of patients with symptom- and screening-detected colorectal cancer

Hermann Brenner, Lina Jansen, Alexis Ulrich, Jenny Chang-Claude, Michael Hoffmeister, Hermann Brenner, Lina Jansen, Alexis Ulrich, Jenny Chang-Claude, Michael Hoffmeister

Abstract

Background: An increasing proportion of colorectal cancer (CRC) patients are diagnosed by screening rather than symptoms.

Aims: We aimed to assess and compare prognosis of patients with screen-detected CRC and symptom-detected CRC.

Methods: Overall and CRC specific mortality over a median follow-up of 4.8 years was assessed according to mode of diagnosis (symptoms, screening colonoscopy, fecal occult blood test [FOBT], other) in a multi-center cohort of 2,450 CRC patients aged 50-79 years recruited in Germany in 2003-2010.

Results: 68%, 11% and 10% were detected by symptoms, screening colonoscopy and FOBT, respectively. The screen-detected cancers had a more favorable stage distribution than the symptom-detected cancers (68% versus 50% in stage I or II). Age- and sex adjusted hazard ratios (HRs) of total mortality with 95% confidence intervals (95% CIs) compared to symptom-detected cancers were 0.35 (0.24-0.50) and 0.36 (0.25-0.53) for screening colonoscopy and FOBT detected CRCs, respectively. HRs were only slightly attenuated and remained highly significant after adjustment for stage and multiple other covariates (0.50 (0.34-0.73) and 0.54 (0.37-0.80), respectively). Even stronger associations were seen for CRC specific mortality. Patients with screen-detected stage III CRC had as good CRC specific survival as patients with symptom-detected stage I or II CRC.

Conclusions: Patients with screen-detected CRC have a very good prognosis far beyond the level explained by their more favorable stage distribution. Mode of detection is an important, easy-to-obtain proxy indicator for favorable diagnosis beyond earlier stage at diagnosis and as such may be useful for risk stratification in treatment decisions.

Keywords: colonoscopy; colorectal cancer; fecal occult blood test; screening; survival.

Conflict of interest statement

There is no conflict of interest.

Figures

Figure 1. Direct adjusted survival curves according…
Figure 1. Direct adjusted survival curves according to mode of cancer detection for A
overall and B. CRC-specific survival, C. non-CRC-specific survival and D, E, F. according to mode of detection and stage at diagnosis (all survival curves were adjusted for age and sex).

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Source: PubMed

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